Successfully transitioning an interruptive alert into a non-interruptive alert for central line dressing changes in the Neonatal Intensive Care Unit.

Abstract

Background: Interruptive alerts are known to be associated with clinician alert fatigue, and poorly performing alerts should be evaluated for alternative solutions. An interruptive alert to remind clinicians about a required peripherally inserted central catheter (PICC) dressing change within the first 48-hours after placement resulted in 617 firings in a 6-month period with only 11 (1.7%) actions taken from the alert.

Objective: To enhance a poorly functioning interruptive alert by converting it to a non-interruptive alert aiming to improve compliance with the institutional PICC dressing change protocol. The primary outcome was to measure the percentage of initial PICC dressing changes that occurred beyond the recommended 48-hour timeframe after PICC placement. Secondary outcomes included measuring the time to first dressing change and, qualitatively, if this solution could replace the manual process of maintaining a physical list of patients.

Methods: A clinical informatics team met with stakeholders to evaluate the clinical workflow and identified an additional need to track which patients qualified for dressing changes. A non-interruptive patient column clinical decision support (CDS) tool was created to replace an interruptive alert. A pre-post intervention mixed-methods cohort study was conducted between January 2022 - November 2022.

Results: The number of patients with overdue PICC dressing changes decreased from 21.9% (40/183) to 7.8% (10/128) of eligible patients (p <0.001), and mean time to first PICC dressing changes also significantly decreased from 40.8 hours to 30.7 hours (p = 0.02). There was universal adoption of the CDS tool, and clinicians no longer used the manual patient list.

Conclusions: While previous studies have reported that non-interruptive CDS may not be as effective as interruptive CDS, this case report demonstrates that developing a population-based CDS in the patient list column that provides an additional desired functionality to clinicians may result in improved adoption of CDS.